Although laser excision has been tried for moles, it is not the method of choice for most deep moles because the laser light doesn't penetrate deeply enough, and there is no tissue remaining to examine pathologically.

Typically, the dermatologist (a skin specialist) may choose excision with or without stitches, depending on the depth of the mole and the type of cosmetic outcome desired.

What is a mole?

Many people refer to a mole as any dark spot or irregularity in the skin. Doctors use different terms. But the following types of skin marks such as these are not treated the same way moles are and are not discussed here:

Risks of Mole Removal

Risks of mole removal methods vary from infection to rare anesthetic allergy and very rare nerve damage. It is always prudent to choose a dermatologist or surgeon with appropriate skills and experience with these removals. This will decrease the risks associated with this procedure.

Other risks vary depending on the area being treated and the method of removal.

One of the most common difficulties after mole removal is a scar. Many people will attempt to remove moles for cosmetic reasons, not realizing that each removal will result in a scar. Many times your surgeon can give you an idea of the type of scar after mole removal before you make your decision about removal.

Mole Removal Preparation

The area to be treated will be cleansed. Depending on the surgeon's preferences, this will be done either with alcohol, Betadine, or another suitable material.

Then the area will be numbed with anesthetic, such as lidocaine. This will not usually take much time to accomplish. Many surgeons prefer to wait after numbing to allow the blood flow to the area to diminish (sometimes up to 10 minutes).

Depending on the size of mole and method used for excision, a sterile drape may be placed over the area to be treated, although the procedure does not need to be done in a sterile environment.

During the Mole Removal Procedure

Removal with simple shaving without stitches

The surgeon takes a scalpel and shaves the mole off flush or slightly below the level of skin.

Then, either an electrical instrument will cauterize or burn the area or a solution will be placed on the area to stop any bleeding.

The doctor will give you instructions on how to take care of your wound. You are usually able to leave the office shortly after.

Removal by excision with stitches

Moles removed by excision (cutting) with stitches are usually in cosmetically sensitive areas where an optimal scar is desired.

The surgeon maps out the mole, cleans the area, and numbs it.

Then a scalpel is used to cut the mole and a border surrounding the mole. The border size depends on the concern of the surgeon for the mole being removed. If there is concern that the mole could be precancerous or cancerous, a larger border will be removed to ensure that the mole itself is completely excised.

Depending on the depth of the mole (how deeply the mole penetrates into the skin), stitches are placed either deep (these are absorbed by the body and do not have to be removed) or on the upper surface of the skin (these don't absorb and will be removed later).

After the Mole Removal Procedure

After the procedure, you need to keep a layer of petrolatum (Vaseline) and a bandage on the wound.

Clean the wound once or twice daily with either water or diluted hydrogen peroxide.

After cleaning the wound, apply the petrolatum and bandage.

These steps are repeated until the wound is healed.

Misconceptions about healing

Some people think that wounds need to be open to the air and that this helps healing. Several studies have disproved this and found significantly quicker healing with bandages and antibiotic salve.

Similarly, vitamin E has been found to slow healing rather than accelerate it, and scars may be worse with vitamin E placed directly on wounds than without it.

There are several scar remedies on the market, including Kinerase Scar Healing Therapy, Skin Medica Scar Recovery Gel, Mederma Skin Care for Scars, Avene Cicalfate Restorative Skin Cream, Kelo-Cote Advanced Formula Scar Gel, and many others. These all have the common feature of covering a scar and providing a healing membrane during and after the initial procedure. These provide little or no benefit over petrolatum alone.

Next Steps after Mole Removal

Simple mole removals are frequently not followed up with an office visit, but this may vary depending on the type of mole.

For lab results: You may receive a phone call from the doctor if there is any indication of unusual features once the tissue has been analyzed by a pathologist. Then you would see the doctor for a follow-up recheck of the area and full examination of the rest of your body.

For stitch removal: Follow-up depends on the area that received stitches and the type of suture that was used. Facial sutures are typically removed within four to seven days. Stitches elsewhere are usually removed from eight to 21 days, depending on the type of suture and the surgeon's preference.

To prevent infection: During the time of the recovery, you need to be careful not to get the area dirty. Also, trauma needs to be avoided to the area, including avoidance of unnecessary stress and strain to the area.

If possible, temporarily discontinue any other blood thinner medications that might slow down healing time. Prior to the procedure, your surgeon will discuss your medications with you and make appropriate recommendations if you are taking blood thinner medications (medications that interfere with blood clotting).

It is rarely necessary to go to the hospital after mole removal. If catastrophic bleeding occurs or if there is an alteration in mental state or severe infection, this will warrant a visit to the hospital's emergency department.

Usually, it is best to call the surgeon's office first to make sure the doctor does not have a suggestion, which may eliminate the need to go to the hospital.

If excessive bleeding occurs, hold firm pressure on the wound for at least 30 minutes.

Also, ice may be applied to the wound for pain management, but ice does not stop bleeding (contrary to popular myth).

Prevention of Moles

Doctors remove many moles every day, but there is always one recurring theme that dermatologists tell people: Be aware of your body and any moles that have changed over time. This is especially true for moles that are dark or flat. Invariably, people will see doctors and be extremely concerned about raised, lightly colored moles, but they are not concerned about the dark, black melanoma (skin cancer) next to the mole. This is truly important.

Additionally, it is imperative to minimize sun exposure and wear sunscreen when you are outside. If you do go to your dermatologist for evaluation, be receptive to a full body mole screening because it is important to look over your entire body rather than ignore areas that you may not be able to inspect regularly.

This is what the area looks like just after the mole has been removed. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

The area of the shave excision is being cauterized. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

The area of the shave excision is now bandaged. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

This mole is a dark, irregularly colored mole that needs to be removed with a deeper excision because the mole cells go farther into the skin. It will be removed by a punch excision process with stitches. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

Prior to numbing the area for excision, it is cleansed with alcohol. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

The punch biopsy has been done, and now the area has the mole in the middle but not yet removed. It will be taken out with forceps (a tweezer-like instrument) and put in a specimen bottle to be sent to the lab for analysis. It is important that every mole be sent for analysis in order to make sure that no atypical cells remain or that it isn't a precancerous type of mole. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com.Click to view larger image.

The forceps is being used to remove the specimen from the area. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

The mole has been removed, and the area is ready for suturing (stitches). Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

The area of the punch excision is being sutured. Photo courtesy Joel Schlessinger, MD, Board Certified Dermatologist, lovelyskin.com. Click to view larger image.

Melanoma

Melanomas most often arise on normal skin, but they may also occasionally occur in conjunction with a benign nevus (beauty mark or birthmark). The identification of potentially malignant pigmented lesions is best remembered by using the first five letters of the alphabet as follows:

A for asymmetry

B for border irregularity

C for color multiplicity

D for diameter greater than ¼ inch

E for evolution (change) in the size and/or shape

Melanomas may ulcerate and bleed and occasionally cause these lesions to itch or burn. In summary, melanomas are most often pigmented, asymmetric with respect to color and shape, and tend to enlarge or change over time. The presence or absence of hair follicles is of no significance.